| NPI | 1871160143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11012101) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9500163) |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2021-10-22 |